Exploring Data and Metrics of Value at the Intersection of Health Care and Transportation Proceedings of a Workshop (2016) / Chapter Skim
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4 Cross-Sector Collaboration to Provide Transportation Services in Rural/Small Urban/Suburban Settings
4 Cross-Sector Collaboration to Provide Transportation Services in Rural/Small Urban/Suburban Settings
Pages 37-52
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From page 37... ...
Suzanne Alewine, the executive director of the Missouri Rural Health Association and co-founder of Community Asset Builders, described HealthTran, Missouri's Rides to Wellness initiative. Dennis Johnson, the executive vice president for policy and advocacy and government affairs at the Children's Health Fund, described using mobile health clinics to bring care to children in underserved communities.
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From page 38... ...
• unding is an issue of significant concern in rural areas (e.g., state funding for F rural transportation is very limited; many rural areas rely on FTA rural funding programs; FTA Section 5311 program funding is limited; programs have expe rienced delays in receiving Section 5310 dollars; the procurement process is cumbersome; health care organizations do not understand the way that rural transit is financed)
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From page 39... ...
People live in environments that do not support them, Kell said, and the Pathways to Better Health of the Lakeshore program links the people of Muskegon to the social determinants of care: housing, transportation, food, utility assistance, and anything else that might improve their health status. Community health needs assessments1 indicated that care coordination was desperately needed, not just among doctors, nurses, and specialty clinics, but across health and social service silos, including transportation, which Kell said was the main barrier for the population.
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From page 40... ...
Patients in all Pathways programs are provided transportation to their Alcoholics Anonymous and Narcotics Anonymous meetings, along with treatment. There was also a $2.4 million cost reduction for the hospital system as a result of decreased use of the ED and increased use of nonemergency transportation and primary care visits.
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From page 41... ...
PRAPARE was designed specifically to aid health centers in gathering data that inform and address individual patient care and population health management, while capturing what makes health center populations unique. However, there are also local-, state-, and national-level goals, including informing advocacy efforts related to local policies concerning the social determinants of health (see Figure 4-1)
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From page 42... ...
Moving forward, the Siouxland Community Health Center will continue to systematically assess for social determinants of health, including
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From page 43... ...
HEALTHTRAN To help address the transportation component of health care access in rural areas, the Missouri Foundation for Health provided the Missouri Rural Health Association with a $500,000 grant over a 3-year period to examine ways to span the gap. This led to the launch of the HealthTran pilot program, which began as a cross-sector collaboration between the Missouri Rural Health Association and the Missouri Public Transit Association and now includes the state primary care association and local health care and transportation organizations.
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From page 44... ...
Federally qualified health centers have a safe harbor under the Anti-Kickback Statute, she explained, which allows them to partner in transportation arrangements. Of the HealthTran riders thus far in the pilot (380 people taking 3,735 scheduled trips)
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From page 45... ...
The Children's Health Fund uses what it learns in its clinical programs to inform its policy and advocacy work to effect change, specifically, to get children into medical homes and help overcome barriers to health for medically underserved children and families. Transportation as a Health Access Barrier The lack of transportation is a critical health access barrier for children, Johnson said, although this fact was not obvious at first, even in a mobile
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From page 46... ...
Through the development of programs, partnerships, and advocacy efforts, the Children's Health Fund is committed to working within its network to improve transportation access and to help ensure that medical appointments are being kept. Johnson highlighted several of the implications of transportation as a health access barrier, particularly for medically underserved children, including missed opportunities for immunizations and routine well-child care; an increased incidence of untreated chronic illnesses (e.g., asthma)
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From page 47... ...
Johnson outlined some of the key elements of the Transportation for Community Health initiative. The initiative is a collaboration of national, state, and local partners; it cultivates local leadership; it builds on a shared understanding of how health access is shaped by a set of social determinants; it prioritizes establishing community trust as a key to progress in planning and decision-making processes; it recognizes that there are likely resource limitations; it encourages innovative approaches to mitigate; and it includes an early periodic screening, diagnosis, and treatment plan for evaluating success (based on a set of core screening benefits embedded within Medicaid for children)
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From page 48... ...
Topics included developing a relationship with the state DOT; cost sharing; making the case for the role of transportation in patient outcomes; and funding, regulatory, and other challenges. Developing a Relationship with the State DOT Carr prompted panelists to describe their relationship with the state DOT and how that relationship has helped to improve and sustain the examples discussed.
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From page 49... ...
He encouraged participants to work with their state DOT and said that, in most states, nonurban funding and specialized transportation funding goes through the DOT. Cost Sharing Carr recalled the discussion of bus passes and vouchers by panelists and asked about other cost-sharing efforts between the transportation and health care communities that have been successful.
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From page 50... ...
Faldmo also reiterated the need for data and expressed optimism at the work of the National Association of Community Health Centers with PRAPARE to quantify the need for transportation to health care. Johnson suggested that the uptake on the health side has been far less robust than it could be and that the transportation sector seems more aware of the need.
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From page 51... ...
Every 2 years the National RTAP conducts a survey of rural transit operators and FTA program managers at the state level. She said that one of the issues for rural transit providers is funding, and she observed that health care organizations often do not understand the way that financing is done for rural transit (e.g., there is often a lack of state matching funds)
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